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Introduction

  • tendons are cords that connect muscles in the forearm and hand to finger bones, and allow the muscles to move the fingers
  • tendons on the back of the hand and forearm straighten or extend the fingers.
    • these tendons are visible just under the skin on the back of the hand
  • tendons on the palm side of the hand and forearm bend or flex the finger
  • inability to flex or extend a finger after a cut to the hand or forearm suggests a tendon injury

Tendon Repair

  • treatment first involves cleansing the wound properly to prevent infection, then repairing the tendon.
  • tendon lacerations on the back of the hand and fingers are close to the skin surface, and can often be repaired under local anesthetic in the emergency room, or in the office.
  • tendon lacerations on the palm side of the hand and on either side of the forearm are much deeper, and must be repaired in the operating room.
  • tendons should be repaired shortly after injury because they begin to shorten, and cannot easily be brought out to their normal length after about 3 weeks.
  • the tendon ends are brought back together and held in place with sutures.
  • the tendon ends then begin to heal together, a process that takes about 6 weeks

Tendon Healing

  • the healing process which sticks the tendon ends together also tends to stick the tendon to the surrounding tissues.
    • this prevents the tendon from sliding, thus preventing motion.
  • Moving the tendon prevents the tendon from sticking to surrounding tissues, but the tendon repair could break if the tendon is moved too much.

Therapy

  • a hand therapist (also called an occupational therapist) works with the patient to optimize tendon function
    • the therapist first makes a splint to protect the tendon repair.
    • the therapist then instructs the patient in special finger and hand movements designed to prevent the tendon from sticking to the surrounding tissues, but not moving the tendon enough to break the repair.
    • the amount of motion allowed is gradually increased as the tendon heals and gains strength.
    • at about 6 weeks, the tendon is strong enough to begin strengthening exercises, and the splint is discontinued


David Y Globerman MD PLLC 

Plastic and Reconstructive

Hand Surgery